Psychosis associated with dementia has recently been validated as a specific syndrome. Knowledge about diagnosis, natural history, and treatment response is evolving rapidly, and is being incorporated into clinical recommendations.

Dr. Mintzer examined various behavioral disturbances associated with dementia and identified those causing serious problems for caregivers. In particular, Dr. Mintzer emphasized that agitation may represent an inappropriate and problematic consequence of behaviors, but may also result from various medical and situational factors.

Dr. Mintzer discussed a tentative treatment algorithm for behavioral abnormalities in dementia. Agitation and aggressive behaviors may improve following a change of environment, such as placement in a behavioral intensive care unit or admission to full or partial hospitalization.

Next, he outlined appropriate pharmacotherapeutic options, which include cholinesterase inhibitors, antipsychotics, antidepressants, anticonvulsants, and anti-anxiety agents. He discussed selection of appropriate pharmacologic agents, dosages, durations of treatment, and approaches to evaluating outcome.

Dr. Mintzer emphasized practical approaches to monitoring for adverse effects and safety concerns, and also described strategies for managing patients who do not respond to or cannot tolerate initial treatment. He discussed the role of combination pharmacotherapy for some patients, and illustrated his discussion with preliminary results of a study of donepezil and risperidone co-administration.

The goals and strategies for managing dementia may differ as a function of the context of care. However, Dr. Mintzer concluded that supplementing pharmacologic treatment with behavioral, interpersonal, and environmental approaches might prove beneficial for psychotic patients with dementia.